Staff and service users at Nelson-Marlborough DHB mental health and acute unit are taking time out together whenever they can, to connect and chat.

The mental health acute unit is a place for people who are experiencing severe mental distress and need specialist inpatient support.

The 20 minute project is simple: staff are encouraged to pause and spend 20 minutes with people on the ward whenever they can. During the 20 minutes, people knit together, play table tennis, share breakfast, or simply chat.

Nathan Davis, inpatient manager at the unit, developed the project and says the need for change came largely from the increase in office based tasks that nurses are expected to complete.

“It’s a really strong driver for me that we’re actually here to engage with people we’re working with. We needed to find a way to get out of the office and onto the floor more so we could do that better,” says Nathan.

Nathan Davis
Nathan Davis, inpatient manager

The project arose as research work for a management course he did through the Te Pou funded Blueprint Leadership Programme in 2013. At first some staff thought the project would take up valuable time and increase their workloads. However the opposite proved true, especially as more and more nurses came on board.

“The more time we spent on the ward, the more nurses started to see a drop in incidents like anti-social behaviour and conflict (which can result in a lot of paperwork). People were spending less time doorknocking their needs were being met, so overall nurses found they had more time in their day. Another thing was that we all began rediscovering a passion for our work; realising how much fun it actually is, and the reason we took up nursing in the first place. I understand why we do those other tasks, but when they come at the expense of helping people towards wellness, that’s a really poor trade off," says Nathan.

Normalising interactions

Nikita Fleming is a registered nurse who has been at the unit for two years. She says she would take her knitting into the ward and people would come and join her, some would not even knit.

“Knowing it was okay for us forget other stuff so we could interact with a person in the ward for 20 minutes was very calming and therapeutic for everybody. It’s a great way to do an assessment of how the person is, but it doesn’t feel like an assessment," says Nikita.

Pauline Nevin is as coordinator for Compass peer support and advocacy service, which provides various forms of support to people at the unit. She’s an occupational therapist by training and agrees the 20 minute project is really good therapy.

Nikita Fleming
Nikita Fleming, registered nurse

Pauline says: “What it allows for is just having normal conversations instead of people being questioned formally about their symptoms or state of mind or whatever. It’s equalising and really improves communication and trust. One thing people told me changed through being around the nurses more was that their feelings and behaviour were better understood and less likely to be taken out of context. Sometimes laughing, crying or being angry is just normal human behaviour and not necessarily a ‘symptom’. This meant they felt they could relax around staff and not always feel like they had to be on their best behaviour."

Modelling leadership

Nathan won a Blueprint Leadership Innovation Award for his work with the 20 minute project. But it wasn’t always easy, with some nurses uncomfortable with a new and unfamiliar approach. To champion the project, he started taking time out of his work once or twice a day to model the activities he wanted to see.

Nathan says: “I wanted to show I was willing to walk the talk. One of the first things I did was come in every day and have breakfast with the people in the ward. I think it became really hard for staff to watch me sitting out there and not get involved themselves.I also made sure I was on the ward during some of the difficult parts of the day like handover, which can be a real crunch time. Being present at those times and the staff seeing how much it was diffusing potential problems became quite a motivator.”

Nikita says Nathan’s subtle approach worked really well because the nurses didn’t feel like they were being forced into anything.

Nikita says: “It was all really relaxed and user friendly, and nurses started getting more involved because they wanted to. It was probably the easiest change management I’ve ever seen. A lot of us are now eating breakfast with the people on the ward and this has really made things easier because we can combine that time with our medications and assessments. That’s much better than standing in the kitchen eating your toast and then having to go out on the ward to do your work.”

Pauline says the breakfast idea is also great from a service user perspective.“There’s so much social interaction around food, and that’s not something people on the ward always get.”

Pauline Devin
Pauline Devin, coordinator

However, Nathan says his job as a leader also means supporting some nurses to become leaders in their own right.

“The idea I wanted to foster was that you don’t need to be in management to lead. Nikita, for example, is a young nurse, but one of the outstanding leaders on the ward. We had a number of nurses who were quick to see the benefits of what we were doing and to get involved and model the changes themselves.

"I was happy for them to try new engagement approaches as long as they were safe – and it didn’t matter if they failed. We’d all discuss what was done and how we might do it better, which really brought the team together and allowed other ‘emerging leaders’ to shine.

"What we’ve tried to do is help our nurses find that pocket of energy and enthusiasm they didn’t know they had – to realise you don’t necessarily have to work harder to get good results. Sometimes it’s just about doing things differently," says Nathan.

A new ward practice

The squares knitted at the unit were sewn into blankets and donated to the local refugee centre, which helped people on the ward understand they could make a big difference to others. For some this was the first time they had received such positive feedback.

The 20 minute project has now become standard ward practice. The next activity is to make as many pompoms as possible to be used as decorations for Christmas 2014. They will be recycled into floor mats for individual residential units in the New Year.

Nathan says they’ll keep adding new ideas and experimenting as they go. “Anything is worth a try as long as it promotes engagement, is easy to pick up and put down, and provides teacher-learner opportunities and that goes both ways!”